Comparison of extra-peritoneal cesarean section with conventional trans-peritoneal cesarean section: An open label randomized controlled trial.

ABSTRACT

Objective: To ascertain whether extra-peritoneal approach is superior to conventional trans-peritoneal approach of cesarean section in terms of fetus delivery time, intra-operative and postoperative outcomes, including return of bowel activity and pain. Study design: An open-label randomized controlled trial conducted over one year and six months at a tertiary care center in India. As per sample size calculation, 68 women enrolled in the study; 34 underwent extra-peritoneal, and another 34 underwent trans-peritoneal cesarean section after randomization. Statistical analysis was done with independent sample 't' test, chi-squared test, and fisher's exact test. Results: Baseline characteristics were comparable in both groups. Fetus delivery time was significantly higher in extra-peritoneal than trans-peritoneal cesarean section (14.26 ± 1.26 vs. 9.38 ± 1.83 min; p = <0.001). Total operation time was also higher in extra-peritoneal than trans-peritoneal approach (63.24 ± 12.74 vs. 57.41 ± 8.62 min; p = 0.027). Whereas average blood loss was comparable in both groups (733.82 ± 219.06 vs. 694.12 ± 351.57 ml; p = 0.063). Postoperatively, return of bowel activity was significantly earlier in extra-peritoneal than trans-peritoneal approach (4.59 ± 0.56 vs. 8.65 ± 1.23 h; p = <0.001). Mean time taken for passage of flatus was also significantly less in extra-peritoneal cesarean section (8.56 ± 0.99 vs. 12.76 ± 2.05 h; p = <0.001). Pain score at 6, 12, and 18 h was significantly lower in extra-peritoneal approach. No patient in extra-peritoneal approach had nausea, vomiting, and abdominal distension. Whereas 11.8 % of patients had nausea, 5.9 % had constipation, and 14.7 % had abdominal distension in trans-peritoneal cesarean section. Requirement of injectable antibiotics and analgesics, and hospital stay was less with extra-peritoneal approach. Conclusion: Extra-peritoneal cesarean section is associated with better postoperative outcomes with respect to return of bowel functions, pain, and requirement of injectable analgesics and antibiotics than the routine trans-peritoneal cesarean section. However, the significantly higher fetus delivery time questions its feasibility in patients with acute fetal distress. Additionally, it is technically difficult and has a longer learning curve.